How I Became a Physician Assistant in Cardiothoracic Surgery

April 3, 2023
I have written a lot of generalized blog posts on the PA experience, but I have yet to take the time to really explain my career. While I’ve known for some time that I wanted to go into the field of Cardiothoracic Surgery, I did not actually get this position right out of graduate school. 
As I have been hosting various events through Blueprint and Rosh Review, I have realized that much like myself many students are passionate about pursuing a career in CTS. So, to help any interested PAs enter this specialty, I’ll be sharing my own experiences (and insights) as I journeyed from PA school to a CTS PA-C role!

Post-PA School Graduation

I graduated from PA school in May 2021. From there, I went on to a fellowship in hospital and critical care medicine that lasted six months. After completing the fellowship, I had a position with that health system working as a hospitalist and managing ICU patients overnight. I actually was in a floater position, so I had experience at a few small hospitals where there were no intensivists overnight, just APPs managing the critical care unit and regular inpatient floors. 

It definitely taught me how to work well under pressure and think critically, but overall the position was not exactly what I was looking for. Therefore, after one year of experience in this position, I opted to pursue my dream specialty.

Trying to Enter CTS Right Out of School

As most people interested in Cardiothoracic Surgery (CTS) know, it can be a very difficult field to get into without any experience. So, despite knowing that I wanted to practice as a CTS PA during school, I was unable to get that role immediately as a new graduate. 

However, just because it did not work out for me that way does not mean it will not work out for you. In fact, some of my current coworkers were initially hired right out of PA school themselves!

Different PA Duties in Cardiothoracic Surgery

As I applied for these PA roles, I found that working as a Cardiothoracic Surgery PA does not always mean working in the operating room. In fact, I interviewed at a few different places and each one had different roles for their PAs. 

The main roles for PAs in CTS are working in either: 

  • The operating room (first assisting in surgery, vein harvesting)
  • Cardiac ICU (dealing with immediate post-op patients or unstable pre-op patients)
  • Inpatient unit (dealing with stable pre-op patients/ post-op patients)
  • Outpatient clinic setting 

Some roles have PAs fluctuating between areas and others have PAs strictly working in one setting. This is very position dependent. In addition, some roles may be primarily cardiac in nature, while others may focus on thoracic and/or vascular areas. 

My Current CTS PA Position

The position I have currently was a dream for me. We primarily are working in the operating room, first-assisting and vein harvesting, and the cardiac ICU managing immediate post-op patients. We also do some work on the inpatient units. Surgically, we work in cardiac, thoracic, and vascular cases.  

In my opinion, the variety in the work we do makes this a very well-balanced position. Given that I have only been in this position for about six months, I am currently in the process of training on vein harvesting and loving every second of it.

The Different Schedule Types of CTS PAs

The schedule for a CTS PA is also very variable and depends completely on where you work! My position is currently in the process of transitioning to four 10-hour shifts per week. We also do work on some weekends and when I am fully trained I will also be on-call on some days, as well. 

Overall, the schedule is just as position-dependent as the role itself can be. Because of this wide variety of options, it is critical to fully understand the role you are applying to in order to make sure you are going to have the job satisfaction you deserve. This is a great specialty to spend a day shadowing in prior to accepting a position, so you can get a feel of the day-to-day lifestyle of your potential coworkers.

The Various Paths to CTS PA Positions

Of course, there are many pathways to becoming a CTS PA. You may find yourself landing a job right out of PA school! Things like cardiothoracic surgery rotations and shadowing hours may increase your chances. 

Otherwise, gaining experience in various specialties could help you become a more desirable candidate. Some examples include:

  • Generalized hospital medicine
  • Critical care medicine (like myself)
  • Cardiology
  • Any sub-surgical specialty 

I noticed this myself, as when I reapplied to positions as a more experienced candidate, there was more interest in my application by potential employers. 

In addition, there are cardiothoracic-specific fellowship opportunities available that you could pursue. Sometimes fellowships are not appealing to PA students due to often having more hours worked for less pay, but they are an excellent way to gain experience and become a great candidate for a CTS position. Sometimes fellowships will even lead to a guaranteed position with that health system.

Best Practices for Pursuing this Role

It definitely takes drive and motivation to succeed in this specialty. PA graduate programs provide you with an excellent overall base knowledge, but in most specialties, you will find that there is still much to learn. CTS can be a very challenging specialty, and if you opt to pursue it you should plan to spend time learning/ researching outside of work hours. 

In addition to studying the fundamentals of CTS patient care, you may also need to spend time practicing surgical techniques. When I first started, I spent a lot of time practicing my different knot-tying techniques. 

Recently, I have been practicing with the device we use for endoscopic vein harvesting so there is no time wasted while training in the OR. It is important to practice and study so you can build trust with your fellow APPs and surgeons because this is a critical specialty that requires a high level of understanding in order to be successful.

Conclusion & Additional Resources

Overall, I am so happy with my current position! I would recommend CTS to anyone who is interested and has the motivation to pursue it. I feel extremely fulfilled in my day-to-day life since transitioning to this specialty, and I believe I finally found my niche when it comes to medicine! 

It was definitely intimidating at first, but I would not have it any other way. I wish you the best in your future endeavors and whatever specialty you choose to pursue!

Interested in learning more about PA specialties and finding a job after graduation? Consider these other great articles on the Rosh Review blog:

Rosh Review is the leader in online test preparation with board exam review for PA students, programs, and PA-Cs across the U.S. Learn more about Rosh Review’s PA-C Qbanks for the PANRE, PANRE-LA, CAQs, and more.

For more info about PA specialties, check out the Is This The Right PA Specialty For You? series that provides practical advice for PAs looking for their right fit.

By Olivia Graham, PA-C

Comments (0)